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GU > UA and Hematuria - Exam 2 > Flashcards

UA and Hematuria - Exam 2 Flashcards

1
Q

What type of sample does UA need to be?

A

clean catch

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2
Q

What color is normal urine? What does cloudy urine represent?

A

norma: “straw yellow” that is translucent

cloudy: pyuria, bacteriuria and diet

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3
Q

What does ammonia odor indicate? fishy?

A

ammonia: bladder retention, long standing urine

fishy: UTI

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4
Q

What does a “strong” urine odor indiate? musty?

A

strong: concentrated urine

musty: PKU

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5
Q

What is the normal urine pH range? What is the average?

A

normal: 4.5-8

average: 5-6

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6
Q

What factors can make urine become more acidic? alkaline? What else can make the urine pH change?

A

Acidic - High-protein diet, cranberries
Alkaline - Vegetarian diet, low-carb diet, citrus

metabolic errors such as urinary stone dz can cause the urine pH to change

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7
Q

With regards to RBC, what can make the urine dipstick test positive? How do you tell the difference?

A

+ if intact RBCs, hemoglobin, or myoglobin in the urine

need to order microscopy to confirm the presence of RBCs

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8
Q

What are some common false positives for heme? false negatives?

A

Menstrual blood contamination
Semen in urine
Vigorous exercise
Concentrated urine (normal - 1,000 RBCs/mL in urine)

High ascorbic acid levels in urine

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9
Q

What is leukocyte esterase? If it pops positive on urine dipstick, what does it indicate?

A

Enzyme produced by WBCs - indicates presence of WBCs

suggests UTI but NOT diagnostic!!

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10
Q

What are some common false negatives for leukocyte esterase? false positives?

A

high specific gravity
glycosuria
urobilinogen
medications (rifampin, phenazopyridine)
ascorbic acid

false positive:
contamination

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11
Q

will normal urine have nitrates? What do nitrates suggest?

A

normal urine does NOT have nitrates

presence of gram - bacteria

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12
Q

What are some common false negatives for nitrites?

A

non-nitrite producing organisms, frequent urination, dilute or acidic urine, urobilinogen

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13
Q

What does bilirubin/urobilinogen make you think?

A

think liver

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14
Q

Urobilinogen: bilirubin metabolism by _______. What would make it increase? decrease?

A

gut bacteria

Increased - hemolysis, hepatocellular disease
Decreased - biliary obstruction, altered gut flora

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15
Q

What would make Bilirubin / Urobilinogen false positive? false negative?

A

False positive - phenazopyridine
False negative - ascorbic acid

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16
Q

What does glucose in the urine make you think? What would cause a false negative?

A

DM or SGLT-2 use

false negative: ketones, ascorbic acid

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17
Q

Are ketones normally found in urine? What are some causes? What would make a false positive?

A

ketones are NOT normally found in the urine

causes: post exercise, fasting, pregnancy

false positive: dehydration, levodopa metabolites

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18
Q

protein on urine dip needs to be _____ or greater to be detected. Test is sensitive for _____ only

A

10mg/dL

albumin only

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19
Q

What would make a urine protein appear to be false positive? false negative?

A

False positive - WBCs, epithelial cells, bacteria

False negative - dilute urine, lower proteinuria levels

20
Q

What does specific gravity of urine tell you?

A

weight of urine compared to weight of water

estimates urine concentration, measures number and size of particles in urine

21
Q

Describe the process of urine microscopy

A

Urine is centrifuged to cause sediment to precipitate.This sediment is then resuspended in a small volume of urine and put onto a glass slide for analysis

22
Q

What is significant for RBCs on urine microscopy?

A

> 5 RBC per HPF on a single occasion OR >3 RBC per HPF on multiple occasions

23
Q

What are some causes of RBCs in urine microscopy? What does the shape tell you?

A

glomerular damage, tumors, trauma, nephrolithiasis, infection, inflammation, nephrotoxins, AKI

Dysmorphic - glomerular disease
Round (normal) - urinary tract epithelial disease or damage

24
Q

What are RBC casts? When would you commonly see them?

A

Mucoprotein with RBCs inside or stuck together

glomerulonephritis, vasculitis

25
Q

When are WBCs in urine microscopy significant? What do they indicate?

A

> 5 WBC per HPF - significant

Indicate injury to urinary tract
Infection, stones, strictures, cancer, glomerulonephritis, interstitial cystitis, AKI

26
Q

What do WBC casts in urine microscopy indicate?

A

WBCs inside or stuck together by mucoprotein

Indicate inflammation of the kidney
Only form in the kidney
Acute pyelonephritis, interstitial nephritis

27
Q

What does a single organism type of bacteria indicate? multiple types of organisms?

A

Single organism = more likely to be infection

Multiple organisms = more likely to be contamination

28
Q

If you suspect an UTI, what do you need to do next? What is important to note about catheterized/suprapubic tap specimens?

A

culture

Catheterized or suprapubic tap - any bacteria = significant

29
Q

What is the MC species of yeast to be found in urine?

A

candida albicans

30
Q

What does tubular epithelial cells in urine indicate? What will you find if lipiduria occurs?

A

Nephrotic syndrome or any tubular degeneration → increased shedding

endogenous fat droplets fill these cells
“oval fat bodies,” “Maltese crosses,” or “grape clusters”

31
Q

What do squamous epithelial in the urine suggest? What does transitional epithelial suggest?

A

Skin surface or outer urethra
Suggest urine contamination

if high numbers, concerning for neoplasms

32
Q

What do hyaline casts indicate? granular casts? waxy casts?

A

hyaline: common and normal

granular: renal damage

waxy: CKD

33
Q

What does a waxy cast look like?

A

Wide, bland-looking casts
Shaped like wide, dilated nephrons

34
Q

What do you need to do next if there is persistent hematuria in the absence of infection?

A

The upper urinary tract should be imaged, and cystoscopy should be performed

35
Q

What OTC medication can make the urine red (false hematuria)? What do you need to do next?

A

azo

Examine urine under a microscope to confirm and to look for microscopic hematuria

36
Q

The presence of WBC and/or Leukocyte Esterase and/or Nitrites indicates possible _______ and may be confirmed by _______ and treated appropriately

A

infection

urine culture (if indicated)

37
Q

Proteinuria and red cell casts indicate ________. What do you need to do next?

A

renal origin

labs and renal imaging +/- nephro consult

38
Q

Urinary cytology and/or cystoscopy with biopsy can assist in the dx of ______

A

bladder neoplasm

39
Q

_______ and ______ have generally replaced IV urography when imaging the UPPER tracts for sources of hematuria. Which one is the imaging of choice?

A

**CT urography (imaging modality of choice)

MR

40
Q

Describe the role of US in hematuria.

A

The role of US of the urinary tract for hematuria is unclear. Although it may provide adequate information for the kidney, its sensitivity in detecting ureteral disease is lower. In addition, its higher degree of operator dependence may further confound its utility.

41
Q

When is IV pyelogram used?

A

An x ray of the urinary tract using contrast medium to visualize urine and possible blockage in the urinary tract

42
Q

When is cystoscopy commonly used?

A

To rule out pathology of the LOWER urinary tract, especially when the pt is actively bleeding to see where the source of the blood is coming from

43
Q

if no obvious reasons for bleeding is found, when do you need to repeat urinary cytology? cystoscopy and upper tract imaging?

A

Urinary cytology can be repeated in 3–6 months

Cystoscopy and upper tract imaging can be repeated after a year

44
Q

When do you need to refer for hematuria?

A

If no infection is present, persistent/recurrent hematuria requires evaluation with urology or nephrology as appropriate

45
Q
A

GU (13 decks)

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